Provider Demographics
NPI:1740796515
Name:ANGEL ACCESS THERAPY, LLC
Entity Type:Organization
Organization Name:ANGEL ACCESS THERAPY, LLC
Other - Org Name:BLUEPRINTUP
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:JILL
Authorized Official - Middle Name:
Authorized Official - Last Name:COLLINS
Authorized Official - Suffix:
Authorized Official - Credentials:LBA
Authorized Official - Phone:615-239-5242
Mailing Address - Street 1:1604 WESTGATE CIR STE 240
Mailing Address - Street 2:
Mailing Address - City:BRENTWOOD
Mailing Address - State:TN
Mailing Address - Zip Code:37027-8578
Mailing Address - Country:US
Mailing Address - Phone:615-239-5242
Mailing Address - Fax:
Practice Address - Street 1:1604 WESTGATE CIR
Practice Address - Street 2:
Practice Address - City:BRENTWOOD
Practice Address - State:TN
Practice Address - Zip Code:37027-1300
Practice Address - Country:US
Practice Address - Phone:615-239-5242
Practice Address - Fax:888-880-5719
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-12-15
Last Update Date:2023-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TN0000000270103K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103K00000XBehavioral Health & Social Service ProvidersBehavior AnalystGroup - Single Specialty